Should I be Concerned???

[David E]

Hey everyone. I've been reading this site for a few days now...ever since my primary care doctor said I needed to see a hematologist for possible BMB. Lots of very helpful information here...Thanks!

I'm a healthy 48 year old white male; normal weight and no symptoms. I've had annual physicals now for the last 10 years and because the last one indicated low (out of range) WBC (4.4), RBC (4.37), & PLT (111), my Dr became concerned. But if I compare these values to the reference range from the last lab I went to last year, the WBC & RBC would be within the normal range? And I had similar values two years ago WBC (4.8), RBC (4.34), & PLT (100).

The other thing I noticed and my Dr did not mention (although he may be factoring into his decision) is that it appears my levels have been slowly dropping over the past 10 years. My platelets have always been considered low, when compared to lab reference range, but WBC & RBC have typically been in the normal range. Here are the high/low values over a 10 year period. WBC (6.2/4.4), RBC (5.2/4.31), PLT (150/100), HGB (15.2/13.3) & HCT (44.2/38.3). The drop has not been a straight line and my lowest values were not necessarily recent but the overall trend has been downward.

So my questions are, is this slow gradual drop typical of AA, ITP or MDS? Do you think maybe my doctor is over-reacting or are his concerns valid? He did not test me for iron but he did test my B12 (765pg/mL) & Folate (>24.0ng/mL) which were normal. My insurance is not the greatest and I'm pretty sure the BMB is going to be very expensive? And scary! Are there other things he could be testing? I did have a bout of anemia as a child (3-4) and was given iron supplementation to correct. Any thoughts or info is greatly appreciated.

Thanks

David

[CatherineJ]

Hi David,

I can understand how stressful the thought of being referred to a hematologist and needing a BMB can be.

I would first ask your doctor what your B12 levels are, low B12 levels can cause low platelets. I think Lupus can also cause low platelets. So you may want to ask about that in addition.

Secondly, ask your doctor to do a viral screen and a blood smear. A blood smear is basically as it sounds, a smear of blood on a slide that a pathologist looks at to see if there are abnormalities. Sometimes certain viruses can cause low blood count.

You can also ask your doctor to consult with other specialists in determining whether you need to be referred to a hematologist if you are particularly concerned about health care costs.

MDS is a diagnosis of exclusion, that is hematologists will usually exclude other possibilities before concluding MDS as the diagnosis, so you want to make sure that your GP is covering the basic grounds for exclusion. As with the other possibilities, I'd hold off on jumping to conclusions yet and worrying too much.

I hope this helps, stay positive.

Best wishes.

[David E]

Thanks Catherine. I appreciate you taking time to reply. I will certainly ask about the viral sceen and blood smear. My B12 was measured at 765pg/mL which appears to be normal based on the lab reference range? I've decided today that I will make an appointment with the hematologist tomorrow rather than try to drag this out with my primary care physician. I'm thinking that may be the quickest way to resolve the issue since the not-knowing is very frustrating. I will come back here and share what happens.

Thanks

David

[cathybee1]

Having your blood counts slowly drop over that period of time is a good reason for your family doc to want you to be checked out further. Seeing a hematologist is a wise decision, David. S/he will probably order more bloodwork as Catherine suggests.

Don't be surprised if the hematologist also suggests you have a BMB -- that is the "gold standard" for diagnosis.

[David M]

David E,

I have experienced similar symptoms as you, although I think mine have "progressed" further than yours at this point. I am also 48 years old... About 12 years ago, doctors noticed during a routine CBC that my counts were low... not dangerously low, but "out of range" low in all the major blood lines -- RBC, WBC, and platelets.

I think when we started regularly monitoring my blood, my platelets were in the 120-130 range. They have gradually dropped over 12 years to 34 at last reading about a month ago. My other blood lines have also dropped some, but perhaps the droppage is not as dramatically seen as in the platelets.

Like you, I still have no (or few) symptoms. At this point, I have had no bruising, bleeding, or infections -- I am thankful to God every day for this! My hemaglobin is below normal as well (was 10.0 at last reading), and this affects my endurance at times, but overall, I feel pretty good and push myself to stay active. Of course, I know others with platelets higher than mine who are experiencing problems -- everyone is different in how they respond to all this. I also have not had to go on any treatment (yet)... no transfusions, no ATG, no BMT... it looks like I am slowy trending that way -- but we'll burn that bridge when we come to it!

I'm sure you are wondering if your "trends" are going to gradually lead you to where I am, and beyond... In your case, it sounds like you really need more data. I'm pretty sure a BMB is in your future...

From what I have read, cases like mine (and possibly yours) where blood counts drop extremely slowly over time are not the "norm" for AA or MDS -- but they do occasionally happen and they are certainly involve bone marrow failure. My doctors have hesitated to label my condition as AA -- they refer to it as pancytopenia. I am still learning, as most of us are, and this web site is a rich repository of information. There are people on this forum who can help you!

Keep us updated on your condition!

David M

[mausmish]

Hi David,

I agree you should see a hematologist. They will be better equipped than your family doctor to diagnose what's going on. You might not need a BMB at this time, depending on what they can determine from blood analysis. If a BMB is suggested, discuss your concerns, financial or otherwise, with the hematologist. Ask why they are recommending and what they're looking for.

Best of luck to you.

Karen

[Marlene]

My husband had low to low normal counts off and on for many years. We were told that "this must be normal for you". Since he really never had blood drawn on regular basis in his youth we had no data prior to the mid 80's. The first we knew was probably in the mid to late 80's. We never gave it any thought. He was healthy, ate well and exercised daily. So he went a pretty long time before something triggered a downward spiral for him.

All I can think is that his bone marrow is his weakest link for some reason and that at some point, something shifted in his health.

Just be sure to rule out the easy stuff and get your iron checked as well as vitamin D, copper and b6. And if you are taking supplements with B12, it can falsely elevate your test results. So I would hold off doing any supplements for about 4 days prior to any blood tests. And for the iron, I would fast before that draw.

[David E]

Thanks for all the replys. I really appreciate the advice. I made an appointment with the hematologist for this Thursday. I'm a little apprehensive but really hope to be able to get some answers.

David

[David E]

Well, I've been seeing a hematologist for the last three months. I've had several CBC's and my platelet counts continue to range between 99 - 115; RBC & WBC have been normal. I've also had countless other laborotory studies, including B12, folate, iron, blood smear, complete viral scan, protein electrophoresis, and abdominal ultra sound (spleen) which were all normal. And just last week I had a BMB with FLOW analysis and those were normal too. Based on these results, my doctor has dianosed me with Chronic ITP. For now I just need to monitor platelet levels twice a year...

Thanks for all the Help

David